Caring for each other #StaffExp


Last Sunday evening saw a flurry of tweets appear from @EmmaSelby following an article in the Mirror about the numbers of nurses who had died by suicide The wonderful @AlysColeKing in response shared the ‘Staying Safe’ resources for people at risk of suicide and those supporting them, which is well worth taking a look at.

Sadly during my career I’ve lost two nurse colleagues to suicide, it’s something that makes me feel incredibly uncomfortable. Helen and Mike will never be forgotten and I am grateful for all they have taught me. However I never want to have to go to a funeral again of a colleague who decided to end their life by suicide, seeing the distress of their families, friends and colleagues is heartbreaking.

Day in and day out staff are faced with the emotional challenge of caring in pressurised environments. So how can we create a culture that thinks and takes action on the psychological safety of staff, allowing us all to ask for help when we need it and experience responses that are compassionate? Achieving this consistently could also help retain our most experienced clinical staff in practice.

The emotional burden of working within in the NHS is not a new one, but increasing mental health pressures, demands on health services to do more for less and reduced funding streams to other public sector services all bring added complexity. There are also often many other pressures that NHS staff face outside work that cause additional emotional distress. For example it worries me that staff in caring roles are significantly affected by domestic violence which is often ‘hidden’ in their day to day professional lives. 1 in 7 nurses experience domestic abuse and NHS staff are three times more likely to suffer domestic abuse than the general public Financial pressures, caring responsibilities and relationship breakdowns at home, along with complexity at work can result in feelings of being totally overwhelmed. We clearly need to strengthen approaches to staff wellbeing.

Organisational commitment and a range of approaches are essential, no one intervention will solve these issues. Having access to independent advice, support and, if appropriate grants to allow choices to be made can be a life line. The Cavell Nurses Trust who are #HereforNurses is one team we can signpost colleagues to so that they get practical, responsive support when things get tough. I am grateful to John, the CEO and the team at Cavell for their amazing work to support nurses and midwives facing crisis or hardship.

Strategically though I wonder if we can be more proactive and work ‘upstream’? I was reading a blog this week about the 5 ‘life skills’ the World Health Organisation @WHO thinks we should all be equipped with

They include:

1. Decision-making and problem-solving

2. Creative thinking and critical thinking

3. Communication and interpersonal skills

4. Self-awareness and empathy

5. Coping with emotions and coping with stress

This seems like a really practical ‘curriculum for life’ that could change the future….

The team around us has a profound role in offering direct support too. I recall a difficult incident very early in my career when a child’s precious Hickman line split, we couldn’t work out why it had happened, previous lines this child had had split too and things just weren’t adding up, things seemed ‘odd’ and even though it all got sorted and the child was kept safe. I went home at the end of the day emotionally drained by the complexity of the situation, I felt hopeless and helpless. I ‘hid’ underneath my duvet and remained there for much of the following day. Of course a hot bath, good sleep, tea & hobnobs, debriefs, supervision with wise colleagues put things into perspective.

Looking back for me this incident highlighted the complexity of healthcare, situations like this can and do lead to staff questioning themselves relentlessly and can result in an emotional downward spiral.

So what can I do personally to stop this spiral, personally and for the team around me? Well I will:

1. ‘Ask for help’ role modelling that this is the norm is so needed by us all I think…

2. Ask questions and be curious, ask how are you, and use ‘tell me more…?’

3. Listen and validate concerns of colleagues

4. Pay attention to my body language and the body language of colleagues when I’m engaging

5. Value the ‘encouragers’ the #EarlyRisersClub on twitter, the tweets of @CreateTheRipple we all need positivity

6. Support and share the work of organisations like Campaign against living Miserably (CALM) and the Samaritans

7. Encourage staff to attend their local Schwatz rounds Or similar supervision/debrief sessions

Being there for each other, recognising that little things can make a huge difference, a thank you when things have been tough, a coffee with colleagues, these things matter. I loved this thoughtful message from Ruth May at a recent event, reinforcing that we all need to take time to recharge.

What are the action/s you’ll take to make self care and staff care a priority, I love some of these suggestions shared on Twitter this week….

And a wise play specialist (thanks Marilyn) gave me these words which I often share and will remain on my wall….

I’ve also been listening to ‘Trauma Stewardship’ on ”Audible’ which was recommended by @MrsBosanquet it’s fascinating, thanks for signposting to this Joanne!

I’d love views on how we can strengthen our approach to caring for each other?

Young Adult Experiences and transition from CYP to adult services #YAExp #BartsHealthYA #ExpofCare #YVS19


I never cease to be inspired by young people, young adults, and it was Hannah a wonderful paediatrician (@HLB27) who kindly emailed me late on Wednesday evening reminding me teenagers ‘are young adults whose brain is developing and are trying to figure stuff out’. When I shared this with my 15 year old daughter she said ‘tell Hannah thanks, that’s exactly it’ impressive feedback! Mike Farquhar (@DrMikeFarquhar) this week encouraged us to ‘be the person you needed when you were young’ to which Arvind Nagra (@arvnagra) highlighted that all young people need someone to connect with, someone to trust, it was Kate Martin (@_Common_Room) who reinforced that often securing that trust takes time, and young people don’t want us to give up on them.

NHS England in collaboration with the ‘I Will Campaign’, the RCPCH and the Youth People’s Health Partnership with amazing organisation from Nagina Javaid (@nagina_j) ran an important youth voice summit with over 100 young people this week, about what mattered most to them in health care, transition and young adult care was a key theme, take a look at #YVS19 for tweets. It was wonderful to have the support of Simon Stevens and Ruth May, both committing to ensure young people’s views inform the work of the Children and Young People’s Healthcare Transformation Programme as the NHS Long term plan is brought to life.

We’ve also been talking about this issue at Barts Health too, the medical board and the children’s board, along with GPs are working collaboratively to improve transition and young adult experiences. Take a look at tweets from our conversations at #BartsHealthYA.

‘Transition’ is defined as the process of moving from children’s to adults’ services, which includes initial planning, the actual transfer between services, and support throughout. But we also need to focus on ‘young adult experience’ #YAExp especially for those who ‘crash land’ into adult services and may not have had the support of Paediatric services.

NICE Guidance on transition asks us to:

1. Involve young people in the design of services, sharing that co-production is key.

2. Ensure we’re considering the developmental level of young people and delivering appropriate care.

3. Identify support beyond the family network, thinking about youth worker roles.

4. Take person centred approaches and involving primary care, so often GPs have been left out of a young person’s care, but this changes when care is then provided by adult services.

5. Foster collaboration between health and social care managers.

6. Think creatively about the value of peer support and the value of technology.

Importantly NICE ask us to pay particular attention to young people with neurodevelopmental disorders; cerebral palsy; challenging behaviour, or who are being supported with palliative care who are most in need of ongoing support, I’d also add young adults from a BAME background need focus too, as they often report poorer experiences of care

We held an event at Barts Health last summer and the wonderful Beci Ward captured what young people wanted from adult services in the graphics below, they asked:

1. For us to be welcoming

2. To involve them in decisions about their care

3. To focus on building trust and keeping them safe

4. To remember how scary it is to be a young person

Another piece of work by teams providing care for young adults identified the following themes as areas that require ongoing focus……

It feels that whilst we’ve been talking about transition for many years, action is taking place. The support from the Roald Dahl Marvellous Children’s Charity supporting transition clinical nurse specialists has been invaluable in building the capacity to focus on this agenda. Follow @nellyfletch71 @angy_wangy1 @SophieDziwinski @RoaldDahlFund for more information.

Perhaps though the most powerful message of the week came from Katie, a young person who spoke to us about her reflections on transition and moving into adult services, her one ask? ‘Please listen to me… I know what works and what doesn’t

…. is that really such a big request?

A post blog note: the RCPCH have brought together transition resources that are worth dipping into



‘I try not to drink too much water when I’m on the ward so I don’t have to leave my child to go to the loo’.

This was a statement shared by Dr Kate Oulton, @DrKateOulton, a Researcher who was sharing her findings from interviews with families who had children with learning disabilities spending time in hospital. Whilst there was positive feedback relating to care in Kate’s NIHR research there was lots to reflect on too, how should we challenge ourselves ‘to do better’ to be kinder and more thoughtful?

Sonja Jacobs @SltSonja has been doing similar work with families who have children with complex needs in Tower Hamlets. Sonja shared the feedback from families about the multiple appointments they face, not knowing who their key worker/consultant is and no access to signposting for peer support. Sonja’s work affirms many of themes in ‘Caring more than most’ research done by the University of Leeds, supported by Contact @contactfamilies, that shows a quarter of parents with disabled children provide an unimaginable 100 hours of care each week, I cannot begin to imagine the exhaustion they face.

Carmen Soto @gourmetpenguin a Paediatrician has also been interviewing families who care for Children with invasive devices e.g. gastrotomies, Hickman lines etc. Carmen shared the privilege of entering homes and seeing the reality of caring for children with complex needs. As a doctor she reflected on the impact kindness has with families. A mum, Willow, who tweets as @riverthistle draws powerful images (TY for sharing on social media Willow) conveying the exhaustion of parents, Willow shared having medical staff acknowledge the caring responsibilities she carries on her shoulders means the world.

The consistent theme that emerges from all of these conversations is the value and impact of kindness from professionals when people are facing such complexity.

But what is kindness? Definitions include it’s the quality of being friendly, generous, they are considerate acts, good deeds, good turns, favours, acts of assistance, service, help or aid.

I think it’s worth busting the myth that ‘being kind’ happens automatically, being kind and thoughtful requires effort and energy.

But where do we get that energy ‘top up’ from to help us be kind in the demands of daily practice? If people are kind to me I’m far more likely to pass on kindness by being kind to others, but if I’m worn down by daily hassles then it follows I’m not going to be as kind in my approach as I’d like to be. The circumstances around us (or some may say culture) such as our colleagues and their behaviours play such an important role in our acts of kindness to others.

However when we’re kind, there are significant personal benefits, it increases our wellbeing and our own feelings of happiness, being kind can reduce the hormones in our brains associated with stress. It also ‘infects’ others with kindness too, as we role model positive behaviours.

Whilst we all have the best of intentions to be kind, the reality is that life is busy with many competing demands, yet I don’t think that should prevent us from exploring thoughtfulness, challenging each other and asking how we can we consistently be kinder? Can we become more intentional in our acts of kindness? When we see acts of kindness by colleagues can we acknowledge them to demonstrate how much they are valued?

Another reflection is that kind people are kind to themselves, creating time for kindness to ourselves is important, so can we commit to this?

Perhaps we start small? Small gestures can mean a great deal to a person who’s having a difficult day, we can offer more focus to acting with good intentions, to see things from the other persons perspective, to put ourselves in their shoes. Reassuringly the reality is kindness isn’t about grand gestures, it’s about thinking of others in often small ways and taking action.

I liked Prof Tony Warne’s @warnetony blog last Sunday he shared he was interviewing consultants and asked them for an example of when they were kind, the results were lovely to read.

Imagine if we asked ourselves at the end of each day ‘how was I kind today?’

Children and Young People’s Health Care Transformation #CYPHCT


The art of the possible….

Excitingly the Children and Young People’s Health Care Transformation #CYPHCT met for the first time this week as we begin to address how we can, together, across the country deliver the CYP elements of the NHS Long Term Plan

Sarah-Jane Marsh @BWCHBoss as magician in chief (or in @NHSEngland speak ‘the chair’) asked us to reflect on why we were there. For me it was a simple response, putting a focus on Child Health is what Children, Young People and families/carers have asked us to do, it’s what will help translate the wonderful work in the National Service Framework (2004), Children’s Outcomes Forum (2014) work along with contemporary evidence provided by the Royal College of Paediatrics and Child Health (RCPCH), amongst others that informed the CYP chapter in the NHS Longterm plan so that we can achieve better health outcomes for and with every child across the country, importantly focusing on those who are most vulnerable. Having a national ‘ask’ is a powerful driver for change at local, Sustainability and Transformation (STP)/Integrated Care System (ICS) levels and across regional patches.

The principles of voice/participation of the child/young person and families/carers not only in their care, but in the design and delivery of services are golden threads that strengthen with each iteration of how we progress the Child Health agenda, here are links to resources that have been developed over the years Having Gabrielle of the NHS Youth Forum @NHSYouthForum at the table influencing the discussions is an important cultural shift, the transformation programme role modelled from the outset that working with children, young people and families who use services is the only way we can really make progress. The NHS Youth Forum response to the Long term plan demonstrates how passionately they want to be part of the work going forward in local health care systems as well as at a national level

Perhaps if I’m honest the key thing that stood out for me from the conversation this week is that there isn’t a blueprint for this improvement work, we can only improve child health by all learning and sharing together, coaching and encouraging each other along the way, and so much great stuff is already happening. We’ve got a real opportunity to share the good stuff as the programme establishes, whether it’s getting children off tube feeds in Tower Hamlets and improving quality of life (along with making significant financial savings), ensuring that accessible information standards are being progressed in Sheffield to improve experiences and make best use of time with practitioners so that everyone’s time is valued, testing out the impact of youth workers in supporting young people with diabetes to reduce complications in later life or implementing the Child Bereavement experience measure (CBEM) to gain insight into the experiences of families when a child dies, there is so much Transformational work happening across the system.

Viv Bennett @VivJBennett and the team at Public Health England have done so much sustained work on the ‘Healthy Child Programme’ that offers a strong foundation as we step forward and onwards to truly transform child health outcomes across the whole system.

I’m excited by what’s ahead particularly as there’s a strong focus on the child health workforce and how we can ensure roles truly meet the evolving needs of child and families going forward, creative and courageous thinking is required!

So as #TeamChildHealth #CYPHCT moves forward, please do tweet, reflect on what matters most to you, share examples of brilliant stuff we need to spread, this programme will live and breath from the energy we all have to make a difference for and with the children and young people that we serve ….

#Movingon #CYPBartsHealth #WeCare Values #Teamwork #BalconyTime

5/4/19 Week 1

This week I started a new job at Barts Health as the Director of Children’s Nursing, Barts Health provide services for Babies, Children and Young People, at the Royal London, Newham, Whipps Cross, Mile End, St Barts Hospitals and Community Services in Tower Hamlets. I’m also working for City University and the East London Health & Care Partnership for one day a week. It’s certainly a diverse and exciting post!

Over the past year I’ve been juggling this post part time alongside my role at NHS England, I’m incredibly grateful to Caroline Alexander the Chief Nurse there (who tweets as @CAlexanderNHS) for offering me this secondment opportunity back in January 2018, which has led to me stepping back into the provider landscape full time. The flexibility of Directors at NHS England including Neil Churchill @neilgchurchill and Kevin Holton who allowed me to do this was appreciated too.

Throughout my career I’ve focused on issues relating to children and young people. Ensuring we offer them the best opportunities and stable foundations to make a difference in their lives is what matters most to me, it’s my ‘why’, seeing them flourish is the most uplifting experience in the world.

One of the things that attracted me to applying for the Director of Children’s Nursing post full time was the team.  When I arrived at Barts Health back in January 2018 I was surrounded by people whose core purpose was also about improving children and young people’s experiences and health outcomes. Yes, there are challenges relating to red tape, limited financial sources, far from perfect environments, yet people have an energy that’s contagious, a desire to work to improve services with a shared purpose of improving the care of the North East London population and beyond. It’s these values that drew me to the team.

Michael West and the Affina Organisational Development team have been working with @NHSBartsHealth for some time. The benefits of this have resulted in time for the Child Health Team to come together, build relationships, reflect on challenges and plan the future. The evidence base that team based coaching improves performance is strong and a series of blogs explores this further

The other key element is that people in the organisation talk about and live the Barts Health ‘we care’ values The aim being is that these values of being: Welcoming; Engaging; Caring; Accountable; Responsive and Equitable are visible in all our interactions to patients, carers and staff. We talked about these values at the Trust induction on my first day, yet as I got out and about this week I’ve seen these values repeatedly brought to life.

Getting IT kit functioning is always a challenge when starting a new job, l was chatting with Spencer as he got my email account up and running on my mobile phone, about why he works in the IT team, to which he answered ‘I help ensure we deliver great patient care, working in the NHS gives me a real purpose to the work I do’.

And then I got to meet public health colleagues based in the Trust and hear about the ‘Horizons programme’ that reaches into schools to connect with young people to offer work experiences, summer schools and careers events. Andrew Attfield @AAttfield talked about his commitment to changing life outcomes through creating pathways into employment for people in local communities.

This tweet from the CEO of Barts Health @A_WilliamsNHS also stood out for me. Project Search offers work placement opportunities to young people with learning disabilities to help them gain experience, Alwen shared how she’d met the young people at Whipps Cross and seen them grow in confidence since the start of the Project Search programme. These young people are often graduates of NHS neonatal and paediatric services, seeing them gain independence through employment is very special and indeed life changing for them and their families.

Seeing the ‘we care’ values lived has been important and something I’ve been reflecting on in my ‘balcony time’ ie the time I use to try and take a step back and think about the activities happening in the busy day to day. Creating this time to reflect is an issue we explored with Dr Gemma Munro @gemmamunro1 on the Ascend Women’s Leadership programme supported by @NHSLLA, I’m going to try hard to ensure I create this space each week. Writing this blog is part of this process as I commute on my daily train journey as I try to untangle my thoughts. I wonder how many of us carve out balcony time? What do you reflect on?

So my frustrations this week include dropping my personal phone down the loo (expensive and hassle inducing mistake), getting new IT kit up and running (still work in progress), constantly asking myself what are the ‘must dos’ here and focusing on that.

It’s been a muddle-some week in many ways, but it’s also been one framed by values, making me question and challenge myself ‘am I living them….?

Remembering Ads the Poet #AdsTalk19 #PatientExperience #PtExp #CYPExp and #Movingon from @NHSEngland


On the 1st April 2013 I joined NHS England as the Lead for Experience of Care, focussing on Babies, Children, Young People and Maternity. I was challenged by trying to define what experience of care meant and if I’m honest I’m still challenged by it today. Getting relational care right ie ‘being with and for people at challenging times’, alongside creating straight forward functional processes ie ‘getting the admin stuff right’ in pleasant environments, along with ensuring competence of staff so that we ‘do the right stuff safely’, all make up our experiences in my view, compassion, competence and safety are inextricably linked.

One book I’ve returned to repeatedly is ‘Understanding Patient Experiences’ edited by Angela Coulter @acpatient and Louise Locock @LLocock amongst others. It’s well worth leafing through a copy at your library.

Of course the NICE Guidance on Adult Patient Experience (2012) offers an evidence based analysis and direction on this agenda and the National Quality Board (2015) published a ‘shared ambition’ of National Bodies to improve experiences In 2018 NHS Improvement published the Patient Experience Improvement Framework

All these resources are helpful but if I’m honest, quite wordy and they tend to focus on adult care rather than the experiences of children and young people. I needed someone to help me understand what good care, good experiences, looked and felt like. It was Adam Bojelian who helped me understand what mattered most to children. Adam tweeted and blogged using a blink technique (something I’m always in awe of) for me he nailed what a good patient experience is in his blog

We used Adam’s work as we toured England running a series of events on Children and Young People’s Experiences of Care following the publication of the results of the CQC Children’s Survey (huge thanks to Ruth Evans and the Patient Experience Network for coordinating these Here’s a blog published by Picker Institute Europe @pickereurope with lots of examples of good practice to help us improve

Adam sadly died in March 2015, yet his legacy lives on and we continue to share his reflections and aim to live up to his standards of good care. Adam was celebrated by the Patient Experience Network as being an outstanding leader in Patient Experience, which he was indeed! See a short film of the celebrations that day in his memory Thanks to Ruth Evans of @PEN_NEWS for recognising Adam’s contribution to #CYPExp work.

Each year Adam’s parents Dr Zoe and Paul who tweet as @4AdsthePoet host a lecture in his honour with support from @horizonleeds @NHSEmployers @NHSConfederation. I had the privilege of doing the first lecture discussing Children’s Participation in HealthCare, ‘Together we can do great things’ in 2016, followed by Rob Webster in 2017 whose lecture ‘Hidden in plain sight’ talked about families, carers and the complex system we as professionals create for people to navigate. Last year Dr Emily Harrop talked about the involvement of children, young people and families in the NICE End of Life Quality Standard. There’s more information on the lectures here

This year we heard from Dr Carmen Soto who tweets as @GourmetPenguin. Carmen’s PhD research focuses on the interaction between children, families and health services. Through conversations with patients and families, she came to deeply appreciate the complexity of the lives of children living with long-term conditions in the real world. Carmen proposes that healthcare professionals can live and work in a “bubble”, often oblivious of the impact that healthcare decisions have on children and their families. In the rich discussion that followed Paul, Adam’s Dad asked us as health professionals for honesty, open/growth mindsets and an ability to release control, Rob Webster challenged us to think about shifting the perspectives of ourselves and colleagues to build trust by establishing shared goals, recognising expertise and building relationships.

This tweet from Willow a parent who participated in Carmen’s research sums it up, the power of human connection and the impact of appreciating the complexities families face….

Adam’s lectures are always a lively gathering of Twitter friends, including John @johnwalsh88, Thines @ThinesG, Denise @denise123_cohen, Sharon @SAPHNAsharonOBE, Rob @NHS_RobW, Louca-Mai @Dr_LoucaMai, Amy @AmyFrounks et al and with many more joining in virtually such as Teresa @agencynurse and Sian @spencer_sian, Gill @whoseshoes thanks to the power of technology. We all meet with a common aim, remembering Adam whilst having an eye on the future, thinking what can we improve, what can we make even better with the people that we serve?

It seems fitting that my final day at NHS England is spent celebrating the contribution of a young man who was so influential on my time in this national role that I’ve had the privilege of doing. These words on a glass block are a little battered now but are often slipped in my pocket ….

Thank you Adam.

Thank you to Dr Zoe & Paul for continuing to share Adam with us all.

#Ultra #Running #NHS1000miles #JurassicCoast


Back in 2016 I thought about doing a marathon. I needed to find one that was fairly low key as I knew I wouldn’t be fast! The Race for Life seemed to offer exactly what I was looking for, a chilled out event whilst raising money for a great cause. Whilst for me it’s not about the times but the experience, I was delighted to finish it in 5:23.

This gave me a taste for doing more marathons and I’m on my way to running a hundred of them (well that’s my goal!), although perhaps run/walking them may be a better description. I’m never going to be fast, but I love the sense of achievement when I’ve completed a run.

The running bug was part of what drove us to establishing #NHS1000miles for #NHS70 with Catherine Wilson and Nicola Jackson and many others, find out more on the ‘We Communities’ blog site

Banking miles for #NHS1000miles has led me to seek out new challenges including dabbling in ultra running, ie anything more than the marathon distance of 26.2miles. In May 2018 Mike and I conquered the Cotswold Way, 107 miles over 3 1/2 days (camping in between) it was a tough but rewarding adventure.

This weekend we’ve been conquering the Jurassic Coast Challenge, 3 marathons in 3 days, goodness the Dorset Coastline has more hills than Wales! 🏴󠁧󠁢󠁷󠁬󠁳󠁿 Dean Royles would call hills ‘character building’ and @Chap_the_man says they are ‘mounds of opportunity’. The hills certainly just kept on giving! Or as the Race t-shirt put it so well ‘they’re hills, get over it!’

Day 1 took us around Portland and over to Lulworth Cove.Day 2 took us from Charmouth back to Portland.

Day 3 took us from Lulworth Cove back to sandy Studland Bay.

So I’ve been reflecting on the lessons running has been teaching me for life…

1. If you’re tired, rest, take in the scenery and then keep going …

2. If you want to drink full fat coke, bits of mars bar or snickers, eat marmite sandwiches, ultras give you a great excuse before getting back on the healthy eating programme after the run 😉. The Votwo organisers sourced great food for us this weekend.

3. Marshals are amazing, they are usually fab volunteers who stand in the cold, rain, wind and encourage you on, the words ‘keep going’ ‘looking strong’ (even if you don’t feel it) mean the world. So I’ll be an encourager…

4. Prophylactic compeed is amazing – we all need stuff to help us, a network of great supporters can make the world of difference in supporting us prevent pain happening …. or even helping us when it does.

5. Take things in ‘bite sized chunks’ tackling long distances 10k or 10miles at a time, seem to make things far more achievable, this seems to be same in life too.

6. And as a famous sports brand reminds us .. ‘Just…..

We’ve had an amazing weekend, with huge thanks to the whole team at Votwo events for superb organisation. We’re hoping we’ll be back soon